Orthotopic ileal neobladder creation according to the original surgical method “Belgrade pouch” – A ten-years experience
Abstract
Background/Aim. The principle of continent urinary derivations is based on the formation of a reservoir as similar as native bladder is, with satisfactory capacity, high level of continence, low pressure and small resorbent surface as possible to prevent metabolic disorders. Methods. This prospective and partially retreospective study included 148 patients with organ confined muscle invasive bladder cancer, operated on in a ten-year period, and followed up in a 3-year period. After a radical cystectomy, an original surgical technique of creating “U” shaped orthotopic neobladder using a short ileal segment, average length of 30 cm, called “Belgrade pouch”, was performed. Results. The results of 126 male and 22 female patients, three years following the surgery, showed average pouch capacity of 477 (330–659) mL, insignificant residual urine of 52 (0–92) mL, and the averageurinary frequency was five times within 24 h. Day time continence was present in 90% of patients and nighttime continence in 88% of patients, 7% of patients had mild acidosis, and 3% of patients had vitamin B12 deficiency. Conclusion. The neobladder created according to the “Belgrade pouch“ technique showed excellent results comparabile with standard techniques, with adequate capacity, high continence rate, favourable 24 h voiding frequency, insignificant residual urine, and a significantly lower rate of metabolic complications during the 3 years of the follow-up period.
References
Alfred Witjes J, Lebret T, Compérat EM, Cowan NC, De Santis M, Bruins HM, et al. Updated 2016 EAU Guidelines on Mus-cle-invasive and Metastatic Bladder Cancer. Eur Urol 2017; 71(3): 462‒75.
Kulkarni JN, Pramesh CS, Rathi S, Pantvaidya GH. Long-term results of orthotopic neobladder reconstruction after radical cystectomy. BJU Int 2003; 91(6): 485‒8.
Hautmann RE, Botto H, Studer UE. How to obtain good results with orthotopic bladder substitution: The 10 commandments. Eur Urol Suppl 2009; 8(9): 712‒7.
Thurairaja R, Burkhard FC, Studer UE. Orthotopic Neoblad-der. BJU Int. 2008; 102 (9 Pt B): 1307‒13.
Bachor R, Frohneberg D, Miller K, Egghart G, Hautmann R. Con-tinence after total bladder replacement: urodynamic analysis of the ileal neobladder. Br J Urol 1990; 65(5): 462‒6.
Constantinides C, Manousakas T, Chrisofos M, Giannopoulos A. Orthotopic bladder substitution after radical cystectomy: 5 years of experience with a novel personal modification of the ileal s pouch. J Urol 2001; 166(2): 532‒7.
Aleksic P, Bancevic V, Milovic N, Kosevic B, Stamenkovic DM, Ka-ranikolas M, et al. Short ileal segment for orthotopic neoblad-der: a feasibility study. Int J Urol 2010; 17(9): 768‒73.
Stenzl A, Sherif H, Kuczyk M. Radical cystectomy with ortho-topic neobladder for invasive bladder cancer: a critical analysis of long term oncological, functional and quality of life results. Int Braz J Urol 2010; 36(5): 537‒47.
Thurairaja R, Studer UE. How to avoid clean intermittent catheterization in men with ileal bladder substitution. J Urol 2008; 180(6): 2504‒9.
Varol C, Studer UE. Managing patients after an ileal orthotop-ic bladder substitution. BJU Int 2004; 93: 266–70.
Kassouf W1, Hautmann RE, Bochner BH, Lerner SP, Colombo R, Zlotta A, et al. A critical analysis of orthotopic bladder substi-tutes in adult patients with bladder cancer: Is there a perfect solution? Eur Urol 2010; 58(3): 374‒83.
Bancević V, Aleksić P, Milović N, Kosević B, Campara Z, Stamen-ković D. Post-voiding residual urine and capacity increase in orthotopic urinary diversion-standard vs. modified technique. Vojnosanit Pregl 2010; 67(7): 558‒61. (Serbian)
Abol-Enein H, Ghoneim MA. Functional results of orthotopic ileal neobladder with serous-lined extramural ureteral reim-plantation: experience with 450 patients. J Urol 2001; 165(5): 1427‒32.
Lawrentschuk N, Colombo R, Hakenberg OW, Lerner SP, Månsson W, Sagalowsky A, et al. Prevention and management of com-plications following radical cystectomy for bladder cancer. Eur Urol 2010; 57(6): 983‒1001.
Shaaban AA, Abdel-Latif M, Mosbah A, Gad H, Eraky I, Ali-El-Dein B, et al. A randomized study comparing an antireflux sys-tem with a direct ureteric anastomosis in patients with ortho-topic ileal neobladders. BJU Int 2006; 97(5): 1057‒62.
Novara G, Ficarra V, Minja A, De Marco V, Artibani W. Func-tional results following vescica ileale Padovana (VIP) ne-obladder: midterm follow-up analysis with validated question-naires. Eur Urol 2010; 57(6): 1045‒51.
Bancevic V , Aleksic P, Milovic N, Spasić A, Kovačević B, Tošev-ski P, et al. Radical cystectomy in eldery. Vojnosanit pregl 2015 72(2): 136‒9.
Nesrallah LJ, Srougi M, Dall'Oglio MF. Orthotopic ileal ne-obladder: the influence of reservoir volume and configuration on urinary continence and emptying properties. BJU Int 2004; 93(3): 375‒8.
Kessler TM, Burkhard FC, Perimenis P, Danuser H, Thalmann GN, Hochreiter WW, et al. Attempted nerve sparing surgery and age have a significant effect on urinary continence and erectile function after radical cystoprostatectomy and ileal or-thotopic bladder substitution. J Urol 2004; 172(4 Pt 1): 1323‒7.
Granberg CF, Boorjian SA, Crispen PL, Tollefson MK, Farmer SA, Frank I, et al. Functional and oncological outcomes after orthotopic neobladder reconstruction in women. BJU Int 2008; 102(11): 1551‒5.
Košević B, Aleksić P, Milović N, Banfevit V, Stamenković D, Nikolić I, et al. Urodynamic characteristics of the modified orthotopic ileal neobladder. Vojnosanit Pregl 2012; 69(3): 253‒6.
Roehrborn CG, Teigland CM, Sagalowsky AI. Functional carac-teristics of the Camey ileal bladder. J Urol 1987; 138(4): 739‒42.
El Bahnasawy MS, Osman Y, Gomha MA, Shaaban AA, Asha-mallah A, Ghoneim MA. Nocturnal enuresis in men with an or-thotopic ileal reservoir: urodynamic evaluation. J Urol 2000; 164(1): 10‒3.
Madersbacher S, Möhrle K, Burkhard F, Studer UE. Long-term voiding pattern of patients with ileal orthotopic bladder sub-stitutes. J Urol 2002; 167(5): 2052‒7.
Mills RD, Studer UE. Metabolic consequences of continent urinary diversion. J Urol 1999; 161(4): 1057‒66.
Burkhard FC, Kessler TM, Mills R, Studer UE. Continent uri-nary diversion. Crit Rev Oncol Hematol 2006; 57(3): 255‒64.
Bančević V, Aleksić P, Stamenković D, Pejčić T, Milović N, Kovačević B, et al. Neobladder “Belgrade pouch”: Metabolic considera-tion. Vojnosanit Pregl 2016; 73(7): 626‒30.
Pajor L. Metabolic conrequences of urinary derivation and bladder substitution. In: Kropfl D, Novak R, Tucak A. Editors. Reconstructive urinary surgery, Zagreb: Medicinska naklada; 1999. p. 243‒6. (Croatian)
Giannini S, Nobile M, Sartori L, Aragona F, Ruffato A, Dalle Carbonare L, et al. Bone density and skeletal metabolism in pa-tients with orthotopic ileal neobladder. J Am Soc Nephrol 1997; 8(10): 1553‒9.
Aleksić P, Bančević V. Creating a neobladder from small intes-tine. Beograd: Draslar publications; 2015. (Serbian)
Mills RD, Studer UE. Metabolic consequences of continent urinary diversion. The J Urol 1999; 161(4): 1057‒66.
Studer UE, Burkhard FC, Schumacher M, Kessler TM, Thoeny H, Fleischmann A, et al. Twenty years experience with an ileal or-thotopic low pressure bladder substitute--lessons to be learned. J Urol 2006; 176(1): 161‒6.
Nieuwenhuijzen JA, de Vries RR, Bex A, van der Poel HG, Mein-hardt W, Antonini N, et al. Urinary diversions after cystectomy: the association of clinical factors, complications and function-al results of four different diversions. Eur Urol 2008; 53(4): 834‒42; discussion 842‒4.